Greek physician Hippocrates of Kos is often considered to be the father of medicine. He is credited with writing or influencing around 60 works, known collectively as the Hippocratic Corpus. One of these is Of the Epidemics, in which he identified painful swelling of the parotid glands ( now known as the salivary glands). This is believed to be the first mention of mumps in medical history. 

Although there were local outbreaks of the disease through the centuries, it took until 1790 for the first description of the disease to appear. In this year, British physician Robert Hamilton wrote about the disease in his paper for the Transactions of the Royal Society of Edinburgh, titled ‘An Account of a Distemper, by the common People in England vulgarly called the mumps’. 

Following its characterisation by Hamilton and further research into the disease, in the 1910s scientists began to investigate the contagious nature of mumps, particularly as it became a serious health threat to armies fighting in the First World War. 

However, it took until 1934 for a breakthrough when US researchers Claude Johnson and Ernest William obtained a filterable cytotropic virus from M. rhesus monkeys’ parotid glands, which had been inoculated with six specimens of saliva from six cases of the mumps. They concluded this virus was the same as the causative agent of mumps.

John Franklin Enders, known for his supportive work on the polio vaccine, medically advised the US War Department during the Second World War on infectious diseases, including the mumps. Using a similar production method to the polio vaccine, Enders developed a vaccine against mumps leveraging a killed virus, however, the immunity it conferred was only short-lived. 

In 1957, US microbiologist Maurice Hilleman started working at Merck. Six years later his daughter, Jeryl Lynn, contracted the mumps, so he cultivated some material from her throat to develop the first live, attenuated vaccine for mumps, which was known as MumpsVax. Until it was discontinued in 2004, an inactivated so-called Jeryl Lynn strain of mumps was still used in the vaccine.  

It was approved by the US Food and Drug Administration in 1967. However, Mumpsvax was never available in the UK, nor was any other vaccine aimed purely at the mumps. 

Hilleman then focused on creating vaccines against other infectious, potentially life-threatening viral diseases – measles in 1963 and rubella, or German measles, in 1969. He brought all this work together to develop the measles, mumps, rubella (MMR) live, attenuated vaccine in 1971. 

This one-of-a-kind, trivalent vaccine combines Merck’s Mumpsvax, Attentuvax for measles based on Enders’ attenuated Edmonston strain of measles and Meruvax II for rubella. Although Hilleman had created his own rubella vaccine, the version used in the MMR product was created by Stanley Plotkin at the Wistar Institute because it was sourced from humans. 

Combination vaccines were, and continue to be, deemed important for public health since they allow for quicker and wider vaccination coverage, and therefore population herd immunity. 

In the UK, the MMR vaccine was recommended as part of the routine immunisation programme for children aged 13 to 15 months in 1988. The government also announced a catch-up vaccination for children of pre-school age. 

Seven years later, in 1996, the government introduced a second dose to children before they went to pre-school.  Further research into the MMR vaccine had revealed that it was most effective after two doses of the vaccine spread out over time. The second dose helps to produce immunity in those who, for some reason, did not gain immunity from the initial dose - a single dose brought immunity to mumps to 78% of recipients, but the second dose successfully conferred immunity in 88% of patients. 

In 1998, former British doctor Andrew Wakefield and 12 of his colleagues published a study in The Lancet, which implied a link between the MMR vaccine and autism. The research was only conducted on 12 patients and had a very uncontrolled design. Wakefield subsequently called for the abandonment of the trivalent and the use of single jabs for the three individual viruses. 

This work received huge media coverage all over the world and caused MMR coverage to fall by 80% across the UK in the late 1990s and early 2000s. 2003 had the lowest recorded MMR vaccine coverage of 79%, threatening herd immunity, putting immunocompromised populations who cannot receive the vaccine at risk.

Almost immediately after the research was published, other scientists began to investigate these claims and concluded there was no link between MMR vaccines and autism – further studies continue to be carried out disproving Wakefield’s claims, the most recent, and largest, was published in 2019. 

In addition, very quickly after publication, ten of the 12 co-authors of the paper retracted the interpretation data stating there was “no causal link” and “the data was insufficient”. It was also later revealed that Wakefield had failed to disclose that he had been funded by lawyers supporting parents in lawsuits against vaccine producers.

The Lancet retracted the paper in 2010, the same year Wakefield was stripped of his medical license by the General Medical Council. 

In 2014, Public Health England (PHE) officially discredited the claims that single vaccines for mumps, measles and rubella would be safer, noting it would “leave children vulnerable to dangerous diseases for longer. Giving three separate doses at spaced out intervals would mean that, after the first injection, the child still has no immunity to the other two diseases.” 

This discrediting of Wakefield’s claims was clearly successful as the UK saw a peak in MMR vaccination rates in 2013 where 94% of five-year-olds had received the first dose and 90% given both doses. 

Although it would be easy to blame anti-vaxxer sentiment for the rise in mumps cases, researchers at Harvard University - Joseph Lewnard and Yonatan Gard - noticed that US outbreaks in 2016 also occurred among those who were vaccinated against the disease. 

They published a study in Science Translational Medicineshowingthat the mumps vaccine only protected people for an average of 27 years. Therefore, recommending there should be a third dose of the vaccine at 18 years of age or later during adulthood; however, this idea would need to be validated in clinical trials.

PHE found that there were 5,042 lab-confirmed cases of mumps in 2019, marking a fourfold jump from 1,066 in 2018. This troubling trend is expected to continue in 2020 since 546 cases had already been confirmed in January this year, compared to 191 in January 2019.  

In response, PHE consultant epidemiologist Dr Vanessa Saliba called for anyone who “may have missed out on their MMR vaccine in the past to contact their GP practice and get up to date as soon as possible". 

Hancock emphasised that the government would respond with a Vaccination Strategy to be launched in spring 2020. This strategy centres around world-leading immunisation programme. The medium-term aim of the programme is to reach 95% uptake of childhood vaccinations, particularly for the second dose of the MMR vaccine, so it equals the successful roll-out of the first dose. 

Since the entire world is now pre-occupied with controlling the spread of the Covid-19 pandemic, it is highly unlikely the UK’s vaccination strategy will come into force this spring. But, could the pandemic, solutions for which focus on finding a vaccine as quickly as possible for vulnerable populations, actually help to temper general anti-vaxxer sentiment to the benefit of general public health?